A Wolf in Sheep's Clothing: A Case of Dilated Cardiomyopathy Presenting with Nonspecific Digestive Symptoms: Insights into Nonocclusive Mesenteric Ischemia

Antoine Kossaify

doi:10.1155/2011/406832

Abstract

We report on a 32-year-old male patient who presented to the emergency room for abdominal pain associated with nausea and vomiting. The patient experienced these symptoms for the last 3 months and was taken in charge on an outpatient basis. Assessment in the emergency room showed hemodynamic collapse, there were no signs of acute surgical abdomen. Emergent cardiac echogram showed severely dilated hypokinetic cardiomyopathy. The diagnosis of acute heart failure associated with nonocclusive mesenteric ischemia was retained. A review of the pertinent literature is presented.

Highlights

Heart failure (HF) patients commonly present with typical signs like fatigue and dyspnea along with lower legs edema when there is right ventricular involvement
We present a case of severe heart failure presenting with nonspecific gastrointestinal (GI) symptoms compatible with Nonocclusive mesenteric ischemia (NOMI)
Laboratory findings revealed negative troponin, mild leucocytosis, serum sodium at 120 mmol/L, creatinine at 1.7 mg/dL, brain natriuretic peptide (BNP) at 3535 pg/mL, Case Reports in Medicine glutamic oxaloacetic transaminase (GOT) at 52 U/L, glutamic pyruvic transaminase (GPT) at 73 U/L, lactate dehydrogenase (LDH) at 271 U/L, and serum lactate at 4.8 mmol/L

Summary

Introduction

Heart failure (HF) patients commonly present with typical signs like fatigue and dyspnea along with lower legs edema when there is right ventricular involvement. Morbidity and mortality from HF are significantly higher when the diagnosis is delayed because of atypical presentation [1]. Nonocclusive mesenteric ischemia (NOMI) is a rare condition complicating the course of heart failure, and it is probably underdiagnosed and is associated with a high mortality rate [2]. Due to its dynamic and intermittent vasospastic physiopathology, NOMI is still a challenging diagnostic concern, and so far there is no standard diagnostic test of sufficient sensitivity and specificity [3]. Diagnosis of NOMI is essential, identification of triggering factors is critical to improve outcome [2, 3]. We present a case of severe heart failure presenting with nonspecific gastrointestinal (GI) symptoms compatible with NOMI

Case Presentation

Discussion

Findings

Conclusion